Hypnosis for the management of COPD-related anxiety and dyspnoea in pulmonary rehabilitation: rationale and design for a cluster-randomised, active-control trial (HYPNOBPCO_2)

Abstract

Complementary psychological care is recommended for COPD, as it significantly reduces anxiety, and boosts the pulmonary rehabilitation efficacy. In a precedent trial (HYPNOBPCO_1, ISRCTN10029862), administering a single hypnosis session was linked to reduced anxiety and improved breathing mechanics in intermediate and advanced COPD patients. However, whether hypnosis could improve self-management of anxiety and dyspnea in COPD during pulmonary rehabilitation is yet to be investigated.This is the protocol for HYPNOBPCO_2, a 2-arm, cluster-randomised, statistician-blinded superiority monocenter trial (NCT04868357). Its aim is to assess the efficacy of hypnosis as a tool to manage anxiety and dyspnea during a Pulmonary Rehabilitation Program (PRP). Clusters of COPD patients eligible to the conventional hospital-based PRP at the Centre Hospitalier de Bligny (CHB), will be randomised and evenly allocated into two parallel arms: “Hypnosis” (treatment) and “Relaxation” (active control). “Hypnosis” will consist of the CHB's conventional 4-week group PRP, supplemented by 2 educational sessions for teaching self-hypnosis. “Relaxation” will be identical, except standard relaxation exercises will be taught instead. Primary end-point will consist of assessing weekly changes in anxiety throughout the PRP, additional to total anxiety change after treatment completion. Anxiety will be determined by the 6-item version of the State-Trait Anxiety Inventory (STAI-6). Secondary outcomes will include change in the 6-minute walking test and the COPD assessment test (CAT). Further follow-up outcomes will include CAT and STAI-6 retests, re-hospitalization rate, action plan use, and persistence in self-hypnosis use, throughout the 12 weeks ensuing PRP completion.

Non-pharmacological Management in Palliative Care for Patients With Advanced COPD

“…Currently, we observe a growing number of studies addressing the issue of the use of non-pharmacological methods in the treatment of COPD patients affected by anxiety. The evaluated interventions included: relaxation ( 79 , 80 ), hypnosis ( 81 ), cognitive behavioral therapy ( 82 ), and mindfulness ( 83 ). One study investigated also breathing techniques and found out them beneficial in managing anxiety ( 84 ).…”

Anxiety and Depression in Chronic Obstructive Pulmonary Disease: Perspectives on the Use of Hypnosis

“…Interestingly, as of 2022, many new trials assessing the impact of hypnotic interventions on depression and anxiety symptoms are currently in progress, which shows that the technique continues to accrue interest in the medical community (e.g., Anlló et al, 2021a ; Grégoire et al, 2022 ; Fernandes et al, ongoing NCT04010825). In particular, at least two of these ongoing trials are targeting the use of hypnosis specifically for the psychological and emotional correlates of COPD ( Anlló et al, 2021b ; Fernandes et al, ongoing NCT04010825).…”